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Atelectasis/Lung Collapse Part-1 by Dr Bashir Ahmed Dar Associate Professor Medicine Sopore Kashmir

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The term atelectasis is derived from the Greek words ateles and ektasis, which mean incomplete expansion.The incomplete expansion of lung may involve part of lung or entire lung.Most symptoms and signs are determined by the rapidity with which the collapse of lung occurs,the size of the lung area affected, and the presence or absence of complicating infection.

Rapid bronchial occlusion with a large area of lung collapse causes pain on the affected side, sudden onset of dyspnea, and cyanosis. Hypotension, tachycardia, fever, and shock may also occur.

Slowly developing atelectasis may be asymptomatic or may cause only minor symptoms. Middle lobe syndrome often is asymptomatic, although irritation in the right middle and right lower lobe bronchi may cause a severe, hacking, nonproductive cough.

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Atelectasis/Lung Collapse Part-1 by Dr Bashir Ahmed Dar Associate Professor Medicine Sopore Kashmir

  1. 1. By Dr Bashir Ahmed Dar '~"‘L ' i Associate Professor Medicine Chinkipora Sopore Kashmir Email: drbashir123@gmail. com
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  5. 5. Note * This slide presentation is divided into three parts. * Part-1 * Part-2 * Part-3 ~ Part two describes collapse of different lobes of lung and how to recognise them and is full of x-rays & Part three deals with treatment. All these slides you can find on slideshare and on some other sites
  6. 6. Definition Loss of lung volume. Atelectasis from Greek word means incomplete expansion. It may affect part or all of the lung Collapsed lung
  7. 7. Atelectasis/ Lung Collapse ° It is a condition where the alveoli are deflated, and devoid of air resulting in loss of volume of lung. ° The air is actually not replaced as distinct from pulmonary consolidation butjust devoid of air
  8. 8. Atelectasis/ Lung Collapse ° Atelectasis may be an acute or chronic condition. 0 In acute atelectasis, the lung has recently collapsed and is primarily notable only for air lessness
  9. 9. Atelectasis/ Lung Collapse ° In chronic atelectasis, the affected area is often characterized by a complex mixture of airlessness, infection, widening of the bronchi (bronchiectasis), destruction, and scarring (fibrosis) of lung tissue
  10. 10. Atelectasis/ Lung Collapse ' The natural tendency for alveoli to collapse is countered by the following: ° Surfactant (which maintains surface tension) ° Continuous breathing (which keeps the alveoli open) ° Intermittent deep breathing (which releases surfactant into the alveoli) ° Periodic coughing (which clears the airways of secretions) Q ,5
  11. 11. Types of atelectasis Obstructive collapse Cicatricial collapse Adhesive collapse ompressive collapse
  12. 12. Obstructive Resorption of alveolar air Bronchial by circulating blood. obstruction Compressive +ve pleural pressure Pleural effusion. Pneumothorax. Cicatricial Pulmonary fibrosis TB Post-irradiation Adhesive Loss of pulmonary RDS — surfactant
  13. 13. Obstructive or Resorptive atelectasis ° Airways may have intrinsic obstruction within its lumen or may be compressed from outside (extrinsic airway obstruction).
  14. 14. Obstructive or Resorptive atelectasis ° Occurs as a result of complete intrinsic or extrinsic obstruction of an airway. ° No new air can enter the portion of the lung distal to the obstruction and any air that is already there is eventually absorbed into the pulmonary capillary system, leaving a collapsed section of the affected lung.
  15. 15. Intrinsic airway obstruction ° Intrinsic airway obstruction is the most common cause of atelectasis in children, and asthma is the most common underlying disorder that predisposes patients to atelectasis.
  16. 16. intrinsic airway obstruction ' Other causes include bronchiolitis, aspiration due to a swallowing disorder, endobronchial tuberculosis, aspiration from gastro esophageal reflux, airway foreign bodies, cystic fibrosis, and increased or abnormal airway secretions for other reasons, thick mucus plug
  17. 17. . I. . V‘? I * Children younger than 10 years are less likely to have developed the inter airway canals of Lambert or the inter alveolar pores of Kohn. ° And these are collateral communications between one alveoli to other or between airways »1l1s2|_ar_§. a_c If -- ‘Y " ‘V. Inc I cell 7 I l , ..: ‘.‘= lypellcell-""T _v V‘ ‘ . PDl£0lKOhlI~7___AV _ . . /1%“ ‘ fi ‘ ‘ "J Capillary ( fl It ~g I ‘A 1 ls‘ ‘ . ' r 1/: _ " “Alveolariuaciophage
  18. 18. intrinsic airway obstruction ° Thus, young children whose airways become obstructed, they are more likely to develop atelectasis than older children who have developed these communications. 9}
  19. 19. Extrinsic airway obstruction ° Extrinsic compression on the airways is most likely to come from enlarged lymph nodes (such as those due to tuberculosis infection), lymphoma and other tumors in the lungs or chest pressing over the airways i mean bronchi larger or smaller and leading to obstruction
  20. 20. Extrinsic airway obstruction Extrinsic or intrinsic obstruction of a lobar bronchus is likely to produce lobar atelectasis; obstruction of a segmental bronchus is likely to produce segmental atelectasis.
  21. 21. Extrinsic airway obstruction ' Middle lobe is also affected commonly because the right middle lobe orifice is the narrowest of the lobar orifices and because it is surrounded by lymphoid tissue, it is the most common lobe to become atelectatic. This is referred to as right middle lobe syndrome. 1
  22. 22. Extrinsic airway obstruction ° Even an enlarged heart that compresses the left main or left lower lobe bronchus, and left-to- right intracardiac shunts that increase blood flow through the pulmonary arteries. ° Loculated collection of pleural fluid for example posterior Loculated collection of pleural fluid can lead to compressed lower lobe atelectasis
  23. 23. Absorption or Resorption or obstructive atelectasis due to intrinsic or extrinsic causes ° The atmosphere is composed of 78% nitrogen and 21% oxygen. Since oxygen is exchanged at the alveoli—capil| ary membrane, nitrogen is a major componentfor the alveo| i's state of inflation. If a large volume of nitrogen in the lungs is replaced with oxygen, the oxygen may subsequently be absorbed into the blood, reducing the volume of the alveoli, resulting in a form of alveolar collapse known as absorption atelectasis Q
  24. 24. Absorption or Resorption or obstructive atelectasis due to intrinsic or extrinsic causes So as I said nitrogen absorption is delayed and slow thus this nitrogen is main gas to prevent collapse and if nitrogen is replaced by high concentration of oxygen then collapse is accelerated
  25. 25. Absorption or Resorption or obstructive atelectasis due to intrinsic or extrinsic causes F° Nitrogen is therefore poorly soluble in plasma, and thus remains in high concentration in alveolar gas and keep the alveoli expanded
  26. 26. Absorption or Resorption or obstructive atelectasis due to intrinsic or extrinsic causes ° If nitrogen is replaced by another gas, that is if it is actively "washed out” of the lung by either breathing high concentrations of oxygen, or combining oxygen with more soluble nitrous oxide in anesthesia, the process of absorption atelectasis is accelerated.
  27. 27. Other causes of diminished alveolar distention include the following ° Small or dysmorphic chest wall ° Severe scoliosis ° Neuromusculardiseases ° Anesthesia or sedation ° Pain from upper abdominal surgery ' Abdominal distention ° Chest wall or upper abdominal pain ° Even it may be caused by deep normal exhalation
  28. 28. Other causes of diminished alveolar distention include the following ° Thoracic and abdominal surgeries are very common causes because they involve general anesthesia, opioid use (with possible secondary respiratory depression), and often painful respiration since cough is suppressed or mucus not cleared leading to obstruction. - A malpositioned endotracheal tube can also cause atelectasis by occluding a mainstem bronchus.
  29. 29. Other causes of diminished alveolar distention include the following ° Suppression of respiration or cough (eg, by general anesthesia, oversedation, severe pleuritic pain) and Supine positioning, particularly in obese patients can all lead to atelectasis ° It is important to realize that alveoli in dependent regions, are particularly vulnerable to collapse in such cases
  30. 30. Linear (plate, discoid, subsegmental) atelectasis ' linear (plate, discoid, subsegmental) atelectasis - a minimal degree of collapse as seen in patients who are not taking deep breaths , such as postoperative patients or patients with rib fracture or pleuritic chest pain. ° The opacities are plate like bands seen on x ray
  31. 31. Linear (plate, discoid, subsegmental) telecasis ° Plate like atelectasis probably due to obstruction of a small bronchus also seen in states of hypoventilation, pulmonary embolism, or lower respiratory tract infection. ° Small bronchi get obstructed by various reasons leading to collapse of small areas
  32. 32. Linear (plate, discoid, subsegmental) atelectasis - These small areas of atelectasis may also happen due to abnormalities in surfactant formation from hypoxia, ischemia, and exposure to various toxins. - Plain film — CT may show relatively thin, linear densities in the lung bases oriented parallel to the diaphragm (known as F| eischner's lines) ° Just to note here kerley B lines start from periphery pleura to hilum run upto 2cm horizontal lines on plain x ray is not the atelectasis , don’t confuse with thick linear bands of opacities of atelectasis
  33. 33. Compression Collapse or Passive (relaxation) atelectasis ° Atelectasis due to compressed lung tissue which is also called as Passive or relaxation of lung collapse or atelectasis occurs most commonly when air, blood, pus, or chyle is present in the pleural space
  34. 34. Compression Collapse or Passive (relaxation) atelectasis ° Intrathoracic abdominal contents, chest wall masses, cardiomegaly, and an abnormal chest wall can also compress adjacent lung tissue. ° Please note here obstructive in which bronchi mainly obstructed and compressive in which lung parenchyma as a whole or part compressed
  35. 35. Compression Collapse or Passive (relaxation) atelectasis ° If a portion of lung enlarges, such as with congenital emphysema, or if focal overinflation occurs for any other reason, it may compress the adjacent lung, causing atelectasis.
  36. 36. Compression Collapse or Passive (relaxation) atelectasis ° Usually occurs when contact between the parietal and visceral pleura is disrupted. ° the two most common specific aetiologies of passive atelectasis are pleural effusion and pneumothorax.
  37. 37. Compression Collapse or Passive (relaxation) atelectasis ° The lung is held close to chest wall because of the negative pressure in the pleural space. Once the negative pressure is lost the lung tends to recoil due to elastic properties and becomes atelectatic.
  38. 38. Compression Collapse or Passive (relaxation) atelectasis ° Negative pressure in the pleura actually permits lung to expand if this negative pressure is lost it will then cause positive pressure in pleura thus will not allow it to expand rather will make it compress and collapse ° There is common misconception that atelectasis is due to compression.
  39. 39. Compression Collapse or Passive (relaxation) atelectasis leads to preservation of shape even when volume is decreased that elasticity is made difficult due to positive pressure outside in pleura ° Generally, the uniform elasticity of a normal lung
  40. 40. Compression Collapse or Passive (relaxation) atelectasis ° The different lobes also respond differently, eg, the middle and lower lobes collapse more than the upper lobe in the presence of pleural effusion, while the upper lobe is typically affected more by pneumothorax.
  41. 41. Cicatricial Atelectasis 0 Alveoli gets trapped in scar unable to expand and becomes atelectatic in fibrotic disorders.
  42. 42. Cicatricial Atelectasis ° Scarring or fibrosis reduces lung expansion. common etiologies include granulomatous diseases, TB, necrotizing pneumonia and radiation fibrosis. ° In short fibrosis due to any cause like chronic lung diseases
  43. 43. Cicatrization atelectasis ° Cicatrization atelectasis results in diminution of volume of lung ° Replacement atelectasis occurs when the alveoli of an entire lobe are filled by tumor (eg, bronchioalveolar cell carcinoma), resulting in loss of volume.
  44. 44. Adhesive atelectasis ° Adhesive atelectasis results from surfactant deficiency or qualitative or quantitative surfactant abnormalities ° Surfactant normally reduces the surface tension of the alveoli, thereby decreasing the tendency of these structures to collapse.
  45. 45. Adhesive atelectasis ° Decreased production or inactivation of surfactant leads to alveolar instability and collapse. This is observed particularly in acute respiratory distress syndrome (ARDS) and similar disorders.
  46. 46. Rounded atelectasis Rounded atelectasis historically called as Folded syndrome Helical atelectasis Blesovsky syndrome Pleural Pseudotumor Pleuroma
  47. 47. Rounded atelectasis ° In rounded atelectasis (folded lung syndrome), an outer portion of the lung slowly collapses as a result of scarring and shrinkage of the membrane layers covering the lungs (pleura). This produces a rounded appearance on x-ray that doctors may mistake for a tumor.
  48. 48. Rounded atelectasis ° Usually a complication of asbestos-induced disease of the pleura, but it may also result from other types of chronic scarring and thickening of the pleura. QB
  49. 49. Rounded atelectasis ° Rounded atelectasis is another variant of segmental or subsegmental atelectasis. Usually located in posterior and lower lobes, lingula, or right middle lobe. ° On CT scan it presents as a subpleural mass, out of which comes out bunch of vessels and bronchi that curve like a comet tail as they enter the atelectatic lung parenchyma (Radiograph and histologically).
  50. 50. Rounded atelectasis ' The diagnosis is made from the characteristic radiologic CT findings. ' Rounded atelectasis generally occur in association with a pleural plaque or a currently present or resolving pleural effusion. ° Below this pleural plaque or thickening or diseased pleural the lung also goes into small coHapse
  51. 51. Rounded atelectasis ° Approximately 70 percent of cases are associated with previous asbestos exposure that is responsiblefor the pleural injury. This finding has also been reported in association with pleural tuberculosis.
  52. 52. Rounded atelectasis ° Furthermore, pleural thickening is always present and is frequently greatest near the mass. The mass often has a curvilinear tail, frequently referred to as the "comet tail sign. ” as i said
  53. 53. b‘- bronchi and blood vessels that extend from the lower border of this rounded collapsed mass to the hilum, creating a whorled appearance of the bronchovascular bundle on CT scan ° This sign is produced by the crowding together of A
  54. 54. Rounded atelectasis ° Not all rounded atelectasis is actually round: Atypical features include wedge-shaped, lentiform, or (less often) irregular opacities or attenuation. Volume loss of the affected lobe is uniformly present, often with hyperlucency of the adjacent lung. Serial examination usually shows a stable appearance.
  55. 55. Rounded atelectasis As I said generally in association with a: pleural plaque Or a currently present or resolving pleural effusion. Can Persist for years Clear spontaneously Gmwmmw If remains stable then no problem and leave it
  56. 56. Rounded atelectasis ° Affected patients typically are asymptomatic, and the mean age at presentation is 60 years. Rounded atelectasis may mimic a Neoplastic tumor. The comet tail sign or talon sign is its distinguishing radiographic characteristic.
  57. 57. bigrns ot coI. Iapse ‘ , / Direct Indirect Special signs A & signs signs / ‘ . /'
  58. 58. Direct Signs of collapse on x ray ° Displacement of the interlobar fissures towards the area of atelectasis (most reliable sign). ° Crowding of the broncho-vascular markings at the collapsed area of lung ° Increased lung opacity (non specific). I/ '
  59. 59. Movement of Fissures ° You need a lateral view to appreciatethe movement of oblique fissures. ° Forward movement of oblique fissure in LUL atelectasis. Backward movement in Lower lobe atelectasis. ° Movement of transverse fissure can be recognized in the PA film
  60. 60. Anterior Horizontal fissure
  61. 61. Indirect signs of collapse on x ray ° Hilar displacement. /Normally left hilum is upto 2cm higher than right hilum - Shift of Mediastinum: The trachea and heart gets shifted towards the atelectatic lung
  62. 62. Indirect signs of collapse on x ray ° Upward displacement of hemidiaphragm ipsilateral to the side of Atelectasis and the normal relationship between left and right side gets altered. Normally right hemidiaphragm is upto 2cm higher than left ° Approximation of/ Ribs and intercostal spaces ° Compensatoryhyperinflation. Q
  63. 63. Alterations in proportion of Left and Right Lung ° The right lung is approximately 55% and left lung 45%. In atelectasis this apportionment will change and can be a clue to recognition of atelectasis.
  64. 64. - Airbronchogram sign — Produced as a result of airspace opacification of the lung parenchyma — This results in visibility of the nonnally invisible black bronchi against a background of white opacification - Seen in consolidation and collapse with at least some patency of the bronchus
  65. 65. Homogenous opacity left upper and mid zones No signs of pushlpull 1 Air bronchogram 1 Homogenous opacity lelt side thorax 2. Loss 0! tell heart border silhouette 2 Classic air bronchogram 3. Left dome diaphragm well seen 3 Loss of left heart border silhouette 4. No evidence of pushlpul 4 Left diaphragm dome well seen 5. Normal CP angles Consolidation left lung upper lobe Including lmgular 6. No volume loss segment
  66. 66. Causes of Air Bronchogram Common Rarr Expiraloni llllll Lymphoma Consolidation Alveolar cell carcinoma Pulmonaiy ocdcma Sarcoidosis llyalinc membrane disease Fibrosing alicoliiis Alveolar prolciriosis Radiation fibrosis ARDS Q
  67. 67. Open bronchus sign ° When air bronchogram is visible in an atelectatic lung, it implies that there is no airway obstruction. It is more a trapped lung with patent airways.
  68. 68. Special signs ° Luftsichel sign: compensatory hyperinflation of the superior segment of the lower lobe in upper lobe collapse which herniates between the collapsed lobe and the mediastinum. ° uxtphrenic peak: a small triangular opacity near the dome of the diaphragm due to stretching of the inferior accessory fissure or inferior pulmonary ligament 0 Broncholobar sign: A lobe collapses around the bronchus that enters it, so that if both the collapsed lobe & the bronchus are seen, they should be related to each other.
  69. 69. Physical Findings of Collapse Lung I Inspection ° Patient having cough I Drooping of Shoulder on the affected side may be present ° Delayed chest expansion on the affected side ° Increased respiratory rate ° Increased pulse ° Possible cyanosis Q
  70. 70. Physical Findings of Collapse Lung ° Palpation I Chest expansion decreased on the affected side ° Tactile fremitus decreased or absent over the involved area I With a large collapse, the trachea may deviate or shift toward the affected side Q/ .._
  71. 71. Physical Findings of Collapse Lung ° Percussion I Dull over affected area I Auscultation ° Breath sounds decreased or absent over involved area ° No adventitious sounds if bronchus is obstructed ° Occasional fine crackles if bronchus is patent / l
  72. 72. / Patterns of atelectasis _ , » I ‘ ‘ ir “ / typical patterni " of collapse ' Round Entire lung Lobar Segmental collapse collapse collapse . f““" K V’ 1/- 3 ubseg mental Iiflt " Ii‘. atelectasis atelectasis
  73. 73. HY Complete white-out of a hemithorax on the chest x—ray has a limited number of causes. The differential diagnosis can be shortened further with one simple observation — the position ofthe trachea. Is it central, pulled or pushed from the side of opacification?
  74. 74. I. Trachea shifted {Trachea pulled [Trachea central} Obstructive Collapse (bronchial cut off) , Pneumonectomy resected 5”‘ / 6”‘ rib Consolidation (air bronchogram) . i Diaphragmatic hernia
  75. 75. 0 I Causes of opacification of a hemithorax 1. Massive pleural effusion 2. Massive collapse 3. Massive consolidation 4. Pneumonectomy 5. Fibrothorax 6. Massive tumor 7. Combination of above lesions 8. Lung agenesis
  76. 76. Complete white-out of a hemithorax Trachea pulled toward the opacified side Massive fibro thorax Pneumonectomy Total or Massive lung collapse Pulmonary Agenesis Pulmonary Hypoplasia
  77. 77. Complete white-out of a hemithorax Trachea pushed toward the opposite of opacified side ° Massive consolidation ° Massive Pulmonary oedema/ ARDS ° Massive Pleural mass: e. g. Mesothelioma ° Massive chest wall mass: e. g. Askin/ Ewing sarcoma
  78. 78. Complete white-out of a hemithorax Trachea pushed toward the opposite of opacified side ° Massive pleural effusion ° Massivediaphragmatichernia ° Massivetumour
  79. 79. Complete white-out of a hemithorax Trachea pulled toward the opacified side ° lf complete white out of hemithorax on x ray is due to pneumonectomy then patient will give you history of surgery done on thorax- thoracotomy and there will be a scar on his thorax even there may be evidence of rib resection on x ray etc
  80. 80. Two types of Pneumonectomy ° Simple pneumonectomy: removal ofjust the affected lung ° Extra pleural pneumonectomy (EPP): removal of the affected lung, plus part of the diaphragm, the parietal pleura (lining of the chest) and the pericardium (lining of the heart) on that side 1.
  81. 81. ._—1___ g
  82. 82. Pneumonectomy D131 .32»: -:1 I-_, .~q l'crWJ'<: d
  83. 83. Wedge resection Lobectomy Pneumonectomy
  84. 84. / . - 1 $3.. 11.2.1, . us. .>>u>. .;. L. _. ,._. m if Pneumonectomy Lobectomy 774! 1 ‘N . /n . . . . . nfi. ..» Ki-. .-uvso T , J.. ... a. , L-s: .u. .»Z? Segmenlcclomy Wedge Resection
  85. 85. l l Figure 1 9A: This PA radiograph of the chest was obtained in a patient following a pneumonectomy for bronchogenic carci- noma involving thc left lung. There is opacification of the left hemithorax with a shift of the mediastinum toward the left side and elevation of the left hemidiaphragm. as indicated by an elevated gastric air bubble.
  86. 86. r Pneumoneciomy The trachea, hila and mediaslinum are deviated to the left. Are they PUSHED or PUllED? ' Lefl . _ morn This patient has had a pneumonectomy I b’°”ChU5 [removal of the left lung] to treat a lung cancer. Hilar and Note the left main bronchus is abruptly cut all : m€dlOSlinOl [arrowhead]. The left hemithorax is tilled by the 1 5”” "fit heart and great vessels which have moved to T the till the space vacated by the removed lung. The right lung has expanded to tilt the space * vacated by the heart.
  87. 87. View larger version: >> In this page >> In a new window V/ é~. ~- ‘4 rt‘ * r. ? l lg‘ Download as PowerPoint Slide at ti" Photo 1 Chest X-ray of a 45-year- old female patient who underwent a right pneumonectomy for stage 2b adenocarcinoma and who presented with postpneumonectomy syndrome 6 months after the operation. Massive mediastinal shift toward the pneumonectomy space as well as stretching ofthe left main bronchus across the
  88. 88. Differential diagnosis of common causes of unilateral lung opacity 1. Tracheal shill Opposite side Same side No shill Same side Costophrenic recess Full, ellaced, blunted Normal Normal Normal Evidence of surgery Nil Nil NIL Yes, no resection 2. Mediastinal shill Opposite side Same side Noshill Same side 3. Thoracic volume Increased Reduced Normal Reduced 4. Signs ol push Seen No No No 5. Signsot pull No Seen No Seen 6. Air bronchogram No : Minima| Marked No 7. 8.
  89. 89. JV If Chest X-ray showing total opacity of the left hemithorax; tracheal shift to the left (dotted arrow). The right lung is hyper inflated and there is a - marked herniation of the right lung across the mediastinum (solid
  90. 90. Signs of ‘push’ (to opposite side ol the lesion) and signs of ‘pull’ (toward same side i ollhe lesion) S: .'uct; :'e i i. i Classic, e. g. Massive pleural elluslon Lobar collapse Trachea Displaced to opposite side Displaced to same side Mediasllnum Displaced to opposite side Displaced to same side lpsilatsralhilum Displaced to opposite side Displaced to same side lnterooslalspaoe widened Narrowed Pulmonary vessels Not seen Crowded Diaphragm ipsilateral side depressed lpsllateral dome pulled up Fissure Not seen Pulled
  91. 91. Massive Pleural Eflusion 2 4 Chest X-ray PA view erect 18%" °' P""""°w°’“' ‘”° Opacity nght hemithorax 2 Twcch? "9 _' "°': ":‘: :‘ Right diaphragm dome obscured " " ‘hm '° ° ° Rm‘ cam” Dom“ obmnd 3 ztediasunal Ihlfl to let! -buck arrow No on btonchogramrbronchovasoular markings 5‘ R79" °""""9'“ °°'"° °b‘°"; d‘b"°‘ '"°‘” Signs of push-modiacstinal shift to loft tracheal shift to loft ' '9” cmhc b°'d°' °b‘°‘“ mama. I 9. “ac” Right massive pleural ettuseon in tenseon lncroaud thoracic volume right 060 V Fig. 3.1: Chest X-ray showing massive pleural effusion
  92. 92. Dileienlialing collapse from consolidation 1. Shape linear. iiedge-shaped Conlinedlolobelbionchopulmonaiysegment 2. Airbronchogram Naibepiesenl Aliiiayspresenl 3. lungiolume loss Present Absent A Signsolpull Present. same side Absent 5. Apex at hilum Yes Apei not centered at hilum
  93. 93. Chest X-ray PA view erect Homogenous opacity right side thorax No bronchovascular marking in right No air bronchogram Tracheal shift to right Cardiac (mediastinal) shift to right Crowding of ribs right Right diaphragm dome and Right cardiac border obscured Signs of pull-same side Right lung collapse I. Tracheal shift to right eide—arrow 2 Cardiac shift to right aide—arrow 3, Loss of right dome diaphragm outline—aiiow 4. Loss of right heart border outline Massive total collapse right side
  94. 94. _-~: r:. ul; c.t: ..: :> Chest X-ray PA view erect No signs ol pushlpull Hornogenous opacity left side thorax 1 Homogenous opacity left side thorax No volume loss 2. Classic airbronchogram 1 Air bronchogram 3. Loss of left heart border silhouette 2. Loss of lelt heart border silhouette 4 Left diaphragm dome well seen 3 Lett dome diaphragm well seen Consolidation left lung upper lobe including Iingular 4 No evidence or pushrpul segment 5. Nonnal CP angles
  95. 95. Left side post-pneumonectomy Evidence ot rib resection left side Opacity lelt side thorax Reduced lelt slde thoracic volume Marlred signs of pul tracheal shill to let mediastinal shift to left crowding or tell slde ribs left heart border obscured lelt dlaphregrn dome obscured slgns ol pull 1. Tracheal shift to let! side 2 Medlestinal ehltt to left 3 Left heart border obscured 4 Lelt diaphragm dome obscured 5 Opacity left hemithorax 8. Air trapped postoperattve complication 7 Rio resedlon-evidence of surgery SIP post-pneumonectomy lelt lung
  96. 96. e S Di h. a O C l l i ll . l H
  97. 97. Pleural effusion I '9! ' ‘. I
  98. 98. In . Mr. in
  99. 99. ,. . , . . . . . .5 . . . r" i. _. . »~ . .‘ . .. . .. 2.. , . i - . . i_. ,i 4 . .i rm. i i , ', ‘ - - , .i . -‘. , - “vki i- In ‘A I -_-i_ _i _i . }‘_. I_i‘. 7-‘r‘. _l _i _~‘: _l _I‘ iyi i_ $1,? _I»/ :‘ ‘ll. If); L; i_ I «_i-_. ' _. -_'-_i__ J~r. g_i -. -~‘, .~ ‘VI '31’-. -‘—i'. _i. _i if-V. ‘-V; Fart " -‘ ‘g ' _. . ‘L, -fr, ‘. ... ‘:_‘ . _i; ?icl‘i. i». i.: I,iiJ. I:) p: ii. t‘; :.. -3: l° Bronchial cutoff sign - Crowding of ribs j , interspaces getting narrowed - Trachea deviated to Rt - Mediastinum shifted heart shifted to Rt - Compensatory hyperinflation of the contralateral lung
  100. 100. ° Atelectasis also show in other forms sharply- defined opacity obscuring vessels without air- bronchogram ° Volume loss results in displacement of diaphragm, fissures, hill or mediastinum as we will see in following x rays
  101. 101. Lung Collapse & Consolidation & Pleural effusion 1. Collapse and consolation can occur independently or together 2. Collapse can be partial or complete 3. It is often not clear to what extent the appearance is due to collapse or consolidation or both. The degrees of each are often unclear.
  102. 102. Lung Collapse & Consolidation 4. If a lobe is only partially collapsed and there is no accompanying consolidation, there may be no increase in opacity 5. In cases of pure collapse, only when the collapse is virtually complete will there be a significant increase in density or opacity of the affected lung
  103. 103. Underlying lung collapse with Massive pleural effusion On x ray Complete opacification of the ipsilateral hemithorax. Mediastinal shift to the opposite side. On CT Scan Chest The collapsed lung opacifies and appear denser than fluid in pleural space. The collapsed lung appears tethered to the hilum. This is relaxation or compression collapse ;
  104. 104. G On x ray Signs of pneumothorax. The lung is tethered to the hilum. There is no increase in lung density until collapse is complete and lung become airless This is also relaxation or compression collapse Lung ii. 4., »--as
  105. 105. A teacher is never a giver of truth: I-Ic is a guide, a pointer to the truth ; that each student must find for himself V’ f

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